Radiation dose management systems—requirements and recommendations for users from the ESR EuroSafe Imaging initiative

Abstract

The European Directive 2013/59/Euratom requires member states of the European Union to ensure justification and optimisation of radiological procedures and store information on patient exposure for analysis and quality assurance. The EuroSafe Imaging campaign of the European Society of Radiology created a working group (WG) on “Dose Management” with the aim to provide European recommendations on the implementation of dose management systems (DMS) in clinical practice. The WG follows Action 4: “Promote dose management systems to establish local, national, and European diagnostic reference levels (DRL)” of the EuroSafe Imaging Call for Action 2018. DMS are designed for medical practitioners, radiographers, medical physics experts (MPE) and other health professionals involved in imaging to support their tasks and duties of radiation protection in accordance with local and national requirements. The WG analysed requirements and critical points when installing a DMS and classified the individual functions at different performance levels. Key Points • DMS are very helpful software tools for monitoring patient exposure, optimisation, compliance with DRLs and quality assurance. • DMS can help to fulfil dosimetric aspects of the European Directive 2013/59/Euratom. • The EuroSafe WG analyses DMS requirements and gives recommendations for users.

Dosimetric quantities and effective dose in medical imaging: a summary for medical doctors

“…The IAEA is preparing a "Joint Position Statement and Call for Action for strengthening radiation protection of patients undergoing recurrent radiological imaging procedures". Dose management systems (DMS) may have a relevant role alerting referrers, radiologists and radiographers on previous examinations to profit from the existing diagnostic information and help to select the best imaging modality and protocol to be used in future [25]. Radiation doses may also be useful to inform patients on the benefits of the procedures and radiation risks, and on the potential need of a clinical follow up for interventional procedures if the skin doses may be near trigger levels [26,27].…”

“…One difficulty in many countries is the lack of a central data base for patient dose values and the difficulty to get the dose values from procedures carried out in different hospitals. Patient DMS may alert on cumulative high doses and this information should be available to the referrers and practitioners [ 28 ].…”

How to Measure/Calculate Radiation Dose in Patients?

“…Recording and processing of patient exposure was driven by the EU-BSS which requires member states of the European Union to ensure justification and optimisation of radiological procedures and store information on patient exposure for analysis and quality assurance [ 4 , 5 ]. Various commercial dose management systems (DMSs) with varying characteristics are available today [ 6 ]. In contrast to radiography and CT, complex RDSR reports are not always correctly and completely saved as DICOM objects in FGI and are not always correctly and completely evaluated by DMS providers.…”

Semi-automatic positioning of the protective screen based on integration with C-arm X-ray device

“…Figures 2 and 3 present examples of indications and relevant solutions of screen management, exstracted from the movie [41]. The application of the solution includes that in the structural report on the radiation dose will be regularly incorporated the assessment of cumulative radiation exposure of occupationally exposed persons in DICOM RDSR format [1,[54][55][56][57][58][59], precisely on the basis of the resolved integration of X-ray device and protective screen, and relevant dosimetric data (based on calculations, whose primary goal is to estimate the reference positioning of the screen) that can be obtained in this way.…”